Next Year, Will Your Employer’s Insurance Cover 62 Services and Products with No Co-Pay or Deductible? How Much Will You Save?

Under the ACA,  some 62 preventive services and products will be free: no copays and the deductible will not apply. The list includes vision checks for children, birth control, and more than a dozen vaccines.

This rule will hold true not just for plans sold in the exchanges, but for most employer-sponsored plans. Under Obamacare, they, too, must offer preventive care without cost-sharing – unless they are “grandfathered.” (Grandfathered plans are policies that existed before the ACA was passed in 2010, and that have not made substantial changes to benefits or cost-sharing since then.)

This year, just 36 percent of Americans who have health benefits at work are enrolled in a grandfathered plan,, down from 48 percent in 2012 and 56 percent in 2011. Each year, more plans will lose their grandfathered status. 

The ACA’s list of preventive services and products covers most of the reasons that many of us visit a physician – for blood pressure checks, cholesterol checks, flu shots, mammograms, tetanus shots, Pap smears or colorectal cancer screening.

Some of us go to the doctor because we want help losing weight, or quitting smoking. Counseling and smoking cessation products – including nicotine patches – all make the list.

If we feel sad, and don’t know why, we may want to be screened for depression. Under Obamacare, this is a free preventive service. If you are a new mother who is feeling blue – or a 60-year-old man who just doesn’t want to get up in the morning – and your primary care physician (PCP) determines that you are depressed, he will send you to a someone who can provide counseling andor medication. The initial consultation with your PCP is free.

Preventive care for kids

As parents, we take our children to doctors for a host of reasons – often because we want advice. “What should I feed a plump six-year old?” “My 14-year-old doesn’  like to leave his room-and he is being teased at school. Should I be worried?”

The ACA lists 25 preventive services for children, including diet counseling, depression screening for adolescents, , oral health risk assessments for children under age 11, behavioral and developmental assessments,  vaccines to protect against 12 diseases, obesity screening and counseling, flu shots and tetanus shots.

      How Much Will You Save? Why Should Men Pay for Contraception?

A woman who uses birth control m”ay save up to $600 a year.

Some men are not happy that part of their insurance premium will pay for contraception. “I’m single and I never plan to have children” one HealthBeat reader grouses. “Why should I pay for it?

There are many answers. But here is an easy one: Women use more preventive services when they are younger, but as men age, the fact that they didn’t go to the doctor for blood pressure screening – or help losing weight – catches up with them. According to the Health Cost Institute, healthcare spending for women exceeds spending for men until age 60. At that point men’s healthcare becomes more costly.  

This is when healthy women begin subsidizing men. Of course, much depends on how long an individual lives. If a fit 70-year-old woman survives until she is 95, she may, in the end, cost society more than an overweight man who has a knee replacement, suffers from diabetes, and dies of heart disease at age 75.

But over the long run, these things even out. Different people need more care at different points in their lives. This is how insurance works: over time, we subsidize each other.

I originally wrote about preventive care on To  find out more about how much you will save, and how free preventive care affects the maximum that you will ever be expected to lay out under Obamacare click here  and scroll down to “Most Won’t Exceed Their Deductibles.”

8 thoughts on “Next Year, Will Your Employer’s Insurance Cover 62 Services and Products with No Co-Pay or Deductible? How Much Will You Save?

  1. Maggie:

    Men have issues also which do not affect women; but, they still pay for it. Androgel is certainly one of them as far as I know. I think sometimes we need to shut up and go with the flow.

  2. Pingback: Angry Bear » Next Year, Will Your Employer’s Insurance Cover 62 Services and Products with No Co-Pay or Deductible? How Much Will You Save? Maggie Mahar Health Beat Blog

  3. Maggie:

    As always you misstate the situation. Insurance benefits are never free or no cost. No one will save anything. The total cost of care will go up and either the policy holders through higher premium or the taxpayers through higher taxes to pay for subsidies is going to pay the cost.

    When that 60 year old man feels he needs someone to talk to because his wife just does not understand him. His Doctor is not going to see him for free somebody pays for the visit.

    If your 14 year old is being teased at school why is it up to me to pay for you to be a better parent.

    Letting everybody go to the doctor for everything is not the answer. The answer to much of the problem is to not place your faith and hope in the medical profession. It is to be a strong individual and take charge of your life. My Grandfather was a doctor. He always said 95% of his patients got well in spite of what he did not because of what he did.

    I pay for insurance on my house based on my investment in it, the deductible I choose and the limits I pick. If you invest more in your house you pay a higher premium. If you want less deductible you pay a higher premium. If you want high limits you pay a higher premium. You don’t force me to choose what you have chosen and I pay for what I choose in home owners insurance.

    If you want everything covered in your health insurance policy fine. You pay for it Don’t ask me to pay for your choices. You pay for them. What can be simpler. You want to take your depressed teen ager to the doctor instead of the karate dojo. Fine. You pay for it. You want your husband that doesn’t get understanding from you to get treatment for depression fine. You pay for it.

    I don’t want those things why should the government or you or anyone tell me I have to buy them. I am sure I am willing to pay for some things that you are not willing to pay for. Watch out for the slippery slope, you may have to pay for me!

    As always fun to read your point of view.


    • Charles–

      First of all, I am very, very sorry to hear that, as you mentioned in your last comment, your wife has been disabled by a stroke.

      But isn’t that one reason why we need access to healthcare for everyone?

      I totally agree with your grandfather–a great many people get better, not because of what a doctor did for them, but because often, the body heals itself. (95% of the time sounds high; but often I don’t go to a doctor and my broken rib heals (not much doctors can do for that) the small broken bone in my foot heals, etc. When it comes to back pain, I have found acupuncture to be far more helpful than Western medicine. (When I woke up one morning with terrible back pain a very good doctor told me to go for acupuncture.)

      Charles–you write that under Obamacare “The total cost of care will go up and either the policy holders through higher premium or the taxpayers through higher taxes to pay for subsidies is going to pay the cost.”

      In fact, since the law passed the total cost of care has gone down–both in the private sector and in the public sector (Medicare and Medicaid)

      Obamacare contains many provisions that have caused hospitals to tighten their belts–becoming more efficient. And many doctors have become more aware when it comes to ordering unncessary tests, etc.

      As for the depressed 60-year-old or the depressed 14-year-old–I would be more than happy to contribute toward making sure that someone else’s depressed husband or teenager has access to screening–rather than letting that person become yet another suicide.

      Finally, you suggest that the answer to our health care problems i “It is to be a strong individual and take charge of your life.”

      MY guess is that your wife is a strong individual, and did her best to take charge of her life.

      But she had a stroke. This was not her fault–or your fault. If a 14-year-old or a 60-year-old suffers from severe depression, this, too, is not his fault–or his parents’ fault or his wife’s fault.

      You write: ” You want your husband that doesn’t get understanding from you to get treatment for depression fine. You pay for it.”

      I can’t even imagine why you think that depressed men are depressed because they don’t get enough understanding from their wives.

      What about depressed wives? What about women who have heart attacks? Would you say that their husbands put them under too much pressure to be perfect wives?

      All of us need access to healthcare. And all of us need to help each other pay for it.
      There but for fortune . .

  4. run 75411–

    You are right that men have their own health problems.

    And very likely there are some preventive services for men that are not as well known and should be covered under the ACA.

    I’m not quite sure what you mean when you say that we should all shut up and go with the flow.

    But I do think the all of us should contribute to funding reproductive services — maternity benefits, etc.– because we all have a vested interest in living in a society where
    children are healthy. After all, we all depend on tomorro-w’s children to help fund our Medicare and Social Security–and to be strong & healthy enough to make this a better world.. .

  5. I have some fear that insurers may start sending out cancellation letters on group plans when their renewal comes up.

    Even though adding preventive services to make their plans compliant might only raise premiums by 5-10 per cent.

    The cancellations in the individual market were really a kind of horror show. Some carriers just saw an opportunity to exit a business which is not very profitable for them. Some states actually required cancellations. In some cases a cancellation was the easiest way for the insurer to get a big rate increase.

    Many parts of the ACA are actually in the hands of unreliable state insurance departments. And/or treacherous insurance companies.

    In an ideal world, the insurers would be required by federal law to upgrade their plans.
    This will not be easy.

    • Bob-

      Insurers ARE required to upgrade their plans.

      Under the Affordable Care Act insurance plans that are not sold in the Exchanges must follow all of the same regs– covering essential benefits, free preventive services, etc.

      The only exceptions are grandfathered plans. (As I explain in the post, the number of grandfathered plans is rapidly shrinking)

      In the large group market insurers are not going to be cancelling policies– in that market, many corporations self-insure. The insurance company just acts as a back office.

      In the small group market insurers cancel policies all of the time. This has nothing to do with Obamacare–it happened pre-Obamacare.

      Similarly, in the individual market where people buy their own insurance, insurers cancel policies all of the time.

      Among people who buy their own insurance only 13% hold onto a policy for two years. Again, this was true pre-Obamacare. In that market
      insurers are constantly cancelling policies and jacking up rates. Obamacare did not “cause” most of these cancellations. That’s just what insurers say in the letters they send out. They don’t want the customers to blame them.

      In most cases, they want the customer to
      buy another one of their plans (a more expensive plan) rather than looking in the Exchange (where they will probably find a better deal.)

      Finally, under the ACA state regulators have stood up and pushed back against insurers who wanted to hike rates. In many cases state regulators said “no” and wouldn’t accept their proposals for pricing in the Exchanges. This is one reason why prices in the Exchanges are significantly lower than